Vendor QA Analyst, Authorization

3 weeks ago

Downers Grove, United States Duly Health and Care Full time
Overview

Good enough isn't for us. Duly Health and Care's team members show up every day driven to exceed expectations. We challenge assumptions and invite dissent to accomplish bold goals and unleash the most extraordinary work of your career. We see and support the remarkable in every person within and beyond the walls of our work.

Duly Health and Care works to understand what matters most to you. We recruit and retain team members who share a relentless passion and pride for helping others live happier and healthier lives. We invest in helping our team members develop their talents in a way that is rich in personal meaning. We invite you to join us, fulfill your purpose and make your mark

Holistic benefits designed to help our team members flourish in all aspects of their lives, including:
  • Comprehensive medical and prescription drug benefits that include medical coverage at 100% (after deductible) when utilizing a Duly provider.
  • $5,250 Tuition Reimbursement per year.
  • 40 hours paid volunteer time off.
  • A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact
  • 12 Weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.
  • 401(k) Match
  • Profit-sharing program
Are you ready to challenge the expected to deliver the extraordinary?

The QA Analyst for Authorization will coordinate, train, optimize and perform QA on the day-to-day activities of vendor management process. Based on the observations from quality audit identify training needs and work with vendors to create curriculum and optimize existing training documents. This position will facilitate training and quality review within the Authorization Department of Duly Revenue Cycle Management. This position trains, implements, monitors procedures/processes for maximum efficiency, productivity, and cost containment. Ensures internal procedures for all areas are in compliance with contractual standards, industry standards, and accepted guidelines of regulatory agencies.

Responsibilities

The Journeys and Adventures that Await:

MAJOR RESPONSIBILITIES
  • Monitor vendor performance against service level agreements (SLAs) and key performance indicators (KPIs) to ensure they meet operational and compliance standards. (25%)
  • Perform quality control reviews to monitor the accuracy and timeliness of HPS authorization. (25%)
  • Based upon observations from quality audits, identify training needs and collaborate to train internal clinical operational areas and vendor teams, such as billing, coding, and patient care, to integrate the authorization services smoothly into the overall RCM process. (15%)
  • Identify and resolve issues related to vendor performance and HPS authorization processes. (15%)
  • Drive continuous improvement initiatives with vendors to enhance service delivery and patient outcomes. (10%)
  • Develop and maintain strong relationships with external vendors specializing in the HPS authorization services. (5%)
  • Facilitate regular reviews and audits to ensure adherence to healthcare regulations and standards, including HIPAA. (5%)
  • Stay updated with changes in healthcare regulations and industry best practices to ensure vendor services remain compliant and effective.
  • Performs other duties as necessary
Qualifications

The Experience You Bring:

MINIMUM EDUCATION AND EXPERIENCE REQUIRED

Level of Education: 5 years or more of experience in i the Registration, Eligibility & Benefit Estimation Healthcare field for large multi-specialty group practice. Training/QA background preferable.

Years of Experience: 5+ years

Describe Type of Experience

MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES
  • Strong understanding of healthcare processes, especially patient registration, eligibility, benefit estimation and compliance requirements.
  • Excellent training and relationship management skills.
  • Strong analytical and problem-solving abilities.
  • Exceptional communication and interpersonal skills.
  • Proficiency in healthcare IT systems and software.
Desirable Experience:
  • Experience with electronic health records (EHR) systems-preferably Epic

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